Provider Demographics
NPI:1295130052
Name:HAYNES, ALEXIS IONA (LICSW)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:IONA
Last Name:HAYNES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 15TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-3505
Mailing Address - Country:US
Mailing Address - Phone:301-356-3382
Mailing Address - Fax:
Practice Address - Street 1:507 15TH AVE NW
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-3505
Practice Address - Country:US
Practice Address - Phone:301-356-3382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3024651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical